Inpatient cognitive therapy: Detours,potholes, and roadblocks along the routes of progress

Developing innovative treatment approaches for psychiatric inpatient settings is an emerging area of interest. This paper delineates the detours and circuitous paths treatment with difficult patients often takes. Differences between typical outpatient and inpatient care are described and the obstacles to cognitive therapy that inpatients present are discussed. The role of case conceptualization is emphasized as a way to promote increased effectiveness. Finally, methods for maximizing therapeutic opportunities with inpatients are suggested.Robert D. Friedberg, Ph.D. is a staff psychologist on the Cognitive Therapy Unit at Mesa Vista Hospital and is an adjunct faculty member at the California School of Professional Psychology.Raymond A. Fidaleo, M.D. is the Clinical Director of the Cognitive Therapy Unit at Mesa Vista Hospital. He is also the Medical Director of the Cognitive Therapy Institute as well as an Associate Professor of Psychiatry at the University of California-San Diego School of Medicine. Dr. Fidaleo engages in private practice in San Diego, CA.Michele M. Mikules, M.A. is a predoctoral psychology intern with the United States Navy at Balboa Hospital, San Diego, CA.